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Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.

Amanda Wilde (Host): Welcome to BayCare HealthChat. I'm Amanda Wilde. More and more often, alternative medicine treatments are being combined with conventional medical care. In this episode, we're going to explore the integrative approach with Dr. Kirksak Jay Poonkasem, Director of Integrative Medicine at BayCare. Dr. Poonkasem, great to have you here.

Kirksak Jay Poonkasem, MD, FAAFP, ABOIM, LMT, NASM-CPT, NASM-CES (Guest): Well, thanks, Amanda. I'm glad to be here with you.

Host: Now my understanding of integrative medicine is that it looks at the whole mind body spirit connection, but what does that really mean? And is integrative medicine the same as holistic medicine?

Dr. Poonkasem: When someone talks about integrative medicine, we really look at the whole person. We look at the whole mind, body, spirit interplay, and that's the important piece. So, we try to look at it from a perspective of the whole person. Oftentimes in medicine, we see patients and we look at just the physical aspects of them. We look at their blood pressure, we look at their pain issues and we only focus on those parts. Integrative medicine really takes a look at everything, their mind, their body, their spirit, whether emotions, mental health, spiritual aspects.

We look at all their health and lifestyle in the complete. And that's the beauty of integrative medicine. And we look at a little bit of everything. So, the mind body spirit connection is really important because when you do something in one, it affects the other. And that's why when we look at integrative medicine and we like to look at the whole picture. Let's take pain for instance. So, if someone comes in complaining of pain, let's say we give them pain medications. All right. It may help a little bit with their physical pain, but if they're having issues with like emotional pain or spiritual pain, we can give them as much pain medications as possible, but it's not going to get rid of their pain completely. So integrative medicine, taking an integrative approach to whatever ails them is going to give them the best chance possible for optimal health and wellness overall. So, we like to look also at lifestyle, components of lifestyle. How is their sleep doing? How's their nutrition doing? How's their exercise and movement doing? We want to look at different things like alcohol intake, if they're smoking. So just get a good idea of the whole total picture when we have a patient to look at and treat.

Host: And then how do you address those issues that are concurrent with something like pain?

Dr. Poonkasem: Yeah, for sure. So when we have a patient that comes in for integrative medicine evaluation, we sit down with them and we try to look at everything. We ask what they're eating, you know how their nutrition aspects are, what are they doing under daily life? What is their daily life like? Try to get an understanding of who they really are. Understand how much exercise they're getting, how much sleep they're getting. Often people neglect sleep, because we're so busy in our daily lives that we say, hey, if we need more time in the day, maybe sleep is where we can take that time away from, but sleep is really important. So we want to make sure that they understand the importance of sleep and how it relates to chronic diseases and illnesses. When you look at the statistics, the chronic diseases in the United States, they're increasing every year and they're the major causes of death, disability and poor health.

When you ask, what are some of these chronic diseases in the US? You look at things like heart disease, cancer, lung diseases, stroke, Alzheimer's disease, diabetes, and chronic kidney disease as some of them. Lifestyle really can influence these chronic diseases. So, when we do look at a patient from an integrative perspective, we use lifestyle as a base, and then we can use other modalities to help assist along the way.

Host: What are some of the other modalities that you use within integrative medicine?

Dr. Poonkasem: Yeah. So, some of the popular modalities out there, you sometimes people think about chiropractic. They think about acupuncture. They think about massage, yoga, meditation, biofeedback, breathing exercises, energy medicine, things of that nature. So there's a lot of different things out there, and that's not an all-encompassing list at all. There's different other techniques, modalities and therapies out there that can be integrative in nature.

Host: So it's important to note that integrative medicine isn't limited to complimentary therapies like acupuncture or herbal medicine, or even supplements, but also exercise and sleep. And you mentioned breathing techniques and I assume other kind of visualizations and meditations as well.

Dr. Poonkasem: Yeah, definitely. It really utilizes any appropriate and evidence informed modalities and therapies to really help the patients achieve optimal healing and wellness.

Host: So what conditions are best treated with integrative medicine?

Dr. Poonkasem: Almost any problem or issue can benefit from an integrative approach. Integrative medicine is really just a way of looking at the patient from the total perspective. It's just one of those things where we want to make sure that we understand the patient completely. Let's say a patient comes in, they have hypertension, for instance, they may be on a medication or started on the medication, but we also want to make sure that they understand the importance of lifestyle in conjunction with the medications. So, let's say if they're having too much salt in their diet, or they're not eating enough vegetables, or they have a lot of processed foods in their diet, we want to make sure we educate them about that foundation. At the same time, we want to make sure that they're getting enough exercise in a day. And when I say exercise, it doesn't mean that they have to be in a gym working out or anything like that. It can be as simple as putting on your shoes and taking a brisk walk around the block or something like that. You know we want to make sure that they're getting enough movement during the day as well.

And then we look at sleep, like I talked about earlier. Sleep is one of those things that we tend to neglect a lot. Stress. We want to look at that person's life and see what stressors do they have in their life and how can we help them mitigate some of those stressors? And can we teach them some techniques to help them get through their day and feel a little bit better and manage their stress a little bit better.

It's not the acute stressors that are detrimental to our health. It's really the chronic stressors through life. If every day you're experiencing chronic stress over and over, that really takes a toll on the body. So, we want to do things and teach patients how we can manage their stress the best. Whether we use meditation, whether we use breathing techniques. There's a whole host of things that we can help teach them.

So we want to really educate them and really get to the root cause of some of the issues that they have. As I was talking about pain management, we have the opiate crisis in the United States as well. That was declared a public health emergency back in 2017. With integrative medicine, it can be helpful in that aspect as well. Acupuncture is a great tool that we can use to help with some of the chronic pain issues. And I think back in 2017, the American College of Physicians published some guidelines for treatment of low back pain. And they actually included acupuncture as a first-line treatment for chronic and subacute low back pain. There's a lot of therapies that we can use within integrative medicine that can potentially be very helpful for the patients and their quality of life without having a lot of side effects at all.

Host: Despite all that, you were saying, chronic disease is on the increase and it increases every year. What have you seen that tells you that the integrative approach is working?

Dr. Poonkasem: When we look at some of these things, we have patient cases that we do. We look at research studies as well. So, when we focus on lifestyle, we do see big changes in their blood pressure, in their weight, in how they feel about themselves as well.

Host: So we were talking about lifestyle before you get a chronic disease, what are some things integrative medicine addresses in terms of preventative care?

Dr. Poonkasem: Integrative medicine again is great for prevention also. So when we go back to lifestyle, we look at things like, it sounds like I'm a broken record. This guy keeps on talking about nutrition. Talks about exercise, talks about sleep, talks about stress, but these really are things that we can do before hand, before these chronic diseases really set in.

And the interesting thing is most of these chronic diseases, they all share the same risk factors and those risk factors are the ones that we talked about, the poor nutrition, lack of physical activity, the tobacco use or exposure, excess alcohol, poor sleep and excessive amounts of stress.

Host: So it's really about changing sometimes your coping mechanisms or other factors in your normal day.

Dr. Poonkasem: Yeah. It's really understanding and learning new ways to cope and manage with things that are thrown at you on a daily basis, because it's really a lifestyle. We look at going into health as a lifestyle. It's not a quick fix. There's no quick fix to any disease or chronic disease out there. It really takes a total picture and a total mindset on how we approach any disease out there. Because there's different factors that are involved and we want to help get to that root cause and do the best that we can. So it really takes a total approach to it. An integrative approach.

Host: Before we go, can you give me one example of something I can do starting today to improve my quality of life?

Dr. Poonkasem: One of the things that you can do right away in improving your quality of life overall is a simple, quick breathing technique. And it's called the 4, 7, 8 breathing technique. I learned this several years ago and a lot of people don't think about breathing. A lot of people say, hey, why should we do some breathing?

So the 4, 7, 8 breathing technique is really something that is quick, fast and free, and it's very effective. So when you do breathing, conscious breathing techniques, it actually stimulates the parasympathetic nervous system. Okay. And that's the resting and digestion. So when we do the four, seven, eight, the four part is inhaling through your nose for a count of four. Seven is holding your breath for a count of seven, eight is exhaling through your mouth for the count of eight. Throughout this whole breathing technique, you want to put the tip of your tongue at the roof of your mouth, right behind the front teeth. You're going to lay it there for the whole duration of the breathing exercise.

So while you're doing 4, 7, 8, that tongue stays up there. Okay. The 4, 7, 8 is one breath. You want to repeat that a total of four times okay. The key to breathing or conscious breathing is to do it on a daily basis. You can use it anytime throughout the day that you're feeling nervous, you're feeling anxious. But the key is if you do practice this on a daily basis, you're really gonna feel benefits from it, more long-term and short term as well.

Host: I was just going to ask, what are the results of doing that a few times a day?

Dr. Poonkasem: Yeah, so you're going to immediately feel a sense of calm come over you. Instead of being scattered and rushing you know, if you're going to go into an important meeting or an interview or something like that, you can do a quick set of four, seven, eight. it takes like less than a minute to do. And you're immediately going to feel that you're grounded again, your body's in a relaxed state and you're able to think clearer, more sharp and move on and move forward.

Host: Yeah, it sounds like it actually focuses your mind so that you can cope better with daily stressors.

Dr. Poonkasem: For sure. Now it really does. And in patients that may have some GI issues, this can really help as well. If they do it on a daily basis for at least four weeks or so, that's when you really start to feel the benefits of that.

Host: This is great advice, because these are little things we can do that daily that affect our overall sense of health and wellbeing.

Dr. Poonkasem: Yeah, for sure. And that really is the key is to really teach patients the little things that they can do on a daily basis to affect their life long-term. Because ultimately, we want to make sure that we get them on a path that they can succeed the best and have the best quality of life moving forward.

Host: Dr. Poonkasem, thank you for your expertise and your insights into integrative medicine and whole-body wellness. I've learned a lot and I think I'll be healthier after this chat.

Dr. Poonkasem: You're very welcome.

Host: And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information, and to get connected with one of our providers.

Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I'm Amanda Wilde. Be well.